Healthcare Provider Details

I. General information

NPI: 1114093168
Provider Name (Legal Business Name): DAVID JEROME HARMON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 WADE HAMPTON BLVD # B
GREENVILLE SC
29615-1152
US

IV. Provider business mailing address

2720 WADE HAMPTON BLVD # B
GREENVILLE SC
29615-1152
US

V. Phone/Fax

Practice location:
  • Phone: 864-268-4335
  • Fax: 864-268-3868
Mailing address:
  • Phone: 864-268-4335
  • Fax: 864-268-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number227
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: